Anorectal Malformation

  • Etiology: congenital, is high if rectal pouch is above levator sling, is low if rectal pouch is below levator sling
  • Imaging: high atresia – rectourethral fistula demonstrated by colostomy injection, enterolith – intraluminal meconium may calcify when mixed with urine from rectourethral fistula
  • Complications: rectoperinal fistula – 95% of anorectal malformation have recto-perineal fistula, in male 50% goes to urethra + 30% goes to seminal vesicle, in female 40% goes to urethra + 30% goes to vestibule + 25% goes to vagina, often have continence issues post op
  • Clinical: have VACTERL syndrome whose anomalies can involve the Vertebral bodies, Anal atresia, Cardiac, TracheoEsophageal fistula, Renal, and Limb (radial ray)

Cases of Anorectal Malformation

AXR of anorectal malformation
AXR shows a distal bowel obstruction with gas down to the rectum. On physical exam the anus was absent.
AXR of cloacal exstrophy
AXR AP shows diastasis of the symphysis pubis and multiple spinal segmentation defects while the AXR lateral shows a small amount of bowel herniated anterior to the abdomen and inferior to the umbilicus along with a large skin covered spinal dysraphism posteriorly and a radioopaque marker being held in place over where the anus should be.
Clinical image of anorectal malformation / imperforate anus
Clinical image shows absence of the anal orifice. There is a good buttock cleft. There were no perineal or scrotal raphe fistula seen.